Learning lessons as “Another One Bites The Dust: On The Death Of A Social Media Site For Doctors.” Like a certain late lamented parrot, CardioExchange is no more. It has ceased to be.
The website was started by the New England Journal of Medicine and the Massachusetts Medical Society more than 5 years ago in the wake of the explosive and ubiquitous growth of social media. But the rise of social media also provoked tremendous uncertainty and even anxiety over its role in healthcare and medicine. In response to this major transformation of the media landscape, MMS and NEJM launched CardioExchange as an experiment in social media for cardiologists and other healthcare professionals interested in cardiovascular medicine.
The founding editor was Harlan Krumholz, who was already working with MMS as the editor of Journal Watch Cardiology. Harlan in turn brought me aboard because of my previous experience (as the founding editor of TheHeart.Org and CardioBrief.Org) with online medical communities.
Social media conquered most of the world rapidly and, it seemed, effortlessly. But in the medical sphere social media faced serious obstacles. Most physicians, in particular, have been nervous or even terrified by the perceived threats of social media. There is a small group of doctors who have embraced blogs and Twitter with enthusiasm, but they are keenly aware of its perils. How can they be genuinely “social” if they are constantly looking over their shoulder, worried about how a simple tweet or status update might be interpreted by diverse and very different groups of patients, colleagues, employers and even total strangers? Perhaps more than any other group, physicians zealously guard their reputation; social media offers the spectre of its destruction in an instant with one wrong tweet or post.
I often joke that running a social media website for physicians is a bit like being the social director on a cruise ship filled with people who have Asperger’s syndrome. It’s an uphill job. But, as I’ve also said before, there’s an important twist: it’s easy to be the social director on a cruise for sorority sisters and fraternity brothers, but you’re probably not going to bring anything to the party that they won’t bring themselves, like yet another 6-pack to a 4th of July party. By contrast, facilitating the use of social media by physicians is not easy, but it can offer something of special value, like bringing water to the desert.
I don’t think the demise of CardioExchange means that social media projects in the medical sphere are doomed. As I discuss below, the site was successful in many important respects, and I think there is a large unmet need for the type of discussions and engagement that bloomed on CardioExchange.
So why didn’t CardioExchange survive?
Let me begin by comparing the startup of CardioExchange with the startup of TheHeart.Org in its early years before it was acquired by WebMD for $19 million. The THO launch, by a small startup company in Montreal, was the most amazing experience of my professional career. There was an intense entrepreneurial spirit. Although we had many disagreements between ourselves about the nature and direction of the site we were creating, every single person in the company was fully, even obsessively committed to the success of THO. It was our only product and our futures depended on it.
By contrast, CardioExchange was an experiment launched by a few people within the vast MMS/NEJM organization. As it turned out the key executive who supported it (Kent Anderson, who is now AAAS’s publisher of the Science family of journals) left MMS almost immediately after the project got underway. Although we continued to receive generous support over the years, it seemed to me that we existed due to the benign neglect of the rest of the large and otherwise-occupied organization. There was never a serious, concerted effort to develop a business model for the site so that it could be sustained. For more than 5 years we remained an experiment without a foundation.
To be clear: everyone with whom I interacted at MMS was first rate. There is no question in my mind that this prestigious organization deserves its reputation for excellence and it was a privilege to work with such intelligent and hard-working people. But it is also true that no one’s job depended on the success of CardioExchange, and in this respect the contrast with THO in its early years could not have been more extreme. In its first years everyone at THO felt and acted like an owner. But within the grand scheme of MMS and NEJM there simply was no compelling urgency to build a viable niche for CardioExchange.
So what did CardioExchange do right? What positive lessons can we take from its demise?
I think CardioExchange showed that physicians can benefit from and enjoy social media. Our audience was never large but it was very devoted. I’ve never seen a medical website that had such a high level of thoughtful and respectful discussion. We’ve all seen the flame wars and the trolls who subvert online medical discussions. We made sure this never happened on CardioExchange.
Over time we adopted a tone and philosophy derived from our editor-in-chief, Harlan Krumholz. Harlan insisted that we encourage and promote a wide variety of views and frank discussions about controversial matters. But he also insisted that the discussions remain polite and respectful. This meant we had to keep a close eye on the exchanges and to take on the role of vigilant gardeners: seeding, watering and fertilizing when appropriate; but also pruning and weeding when necessary.
(There’s an interesting corollary lesson to be taken from this intense, frequent curation, which required a lot of internal discussion among the editors and staff. One of my greatest disappointments is that we were often unable to recreate online the passion and intellectual fireworks of our offline discussions. By the time discussions migrated online they had lost much of their urgency and intensity. I think this problem illustrates the perilous nature of social media for physicians. Many have worthwhile and provocative viewpoints, but they are also often afraid to share them in unfiltered form.)
One of our greatest successes, IMO, came from a very simple idea. After a brief internal consultation among the editors we posed a few brief questions to the authors of important or interesting papers recently published. We tried to ask what knowledgeable clinicians would want to know about the meaning and implications of their papers. In some cases we asked them to address controversial issues raised by their papers. In other cases we wanted to know how their findings should be interpreted in clinical practice.
Over the years this format proved extremely popular. On several occasions I believe we helped focus the reception of an important new study and fostered intelligent discussion. When it came out the TACT trial, which tested chelation therapy in heart patients, was enormously controversial. Our detailed Q&A with the investigators helped establish a civil discussion. shedding light on the subject and helping to disperse much of the excessive heat. We were able to put to rest many rumors about the conduct and design of the trial. Similarly, when the PARADIGM-HF trial came out last summer, CardioExchange provided a forum for discussion that allowed the trial investigators to respond to their critics. The CardioExchange posts did not, of course, resolve all differences of opinion, but they did completely remove the frustration often felt by participants on different sides of a controversy that their perspective has not been adequately presented to the other side. It should also be noted that in these cases, and many others, members of the CardioExchange community played an important role in asking questions and providing additional valuable insights.
I think there can and will be online communities for physicians in which they can ask questions and exchange ideas and I think a commercial model can be developed to support this. But I also think that some of the current efforts in this direction, which have economic models based on selling industry either information or access to physicians, are untenable. Inevitably, the interests and needs of independent medical professionals will clash with the commercial interests of the sponsors.
Repost from Forbes by Larry Husten.